Emergency Scenario 600_f2_478

Location Information

Hafnarstræti 18, 600 Akureyri, ground floor of a two-story commercial building, currently operating as a small café. Main entrance is at street level, no steps. Secondary entrance at the back leading to a small parking area. Building is made of concrete, constructed in 1965. No security features beyond a standard lock on the main door. Weather conditions: 8°C, overcast, light wind. GPS coordinates: 65.6821° N, 18.0912° W. Nearest landmark: Akureyri Art Museum.

Emergency Details

31-year-old male experiencing severe respiratory distress. Primary symptoms: Acute onset of shortness of breath, wheezing, and chest tightness. Patient is pale, anxious, and struggling to speak in full sentences. Secondary symptoms: Mild cyanosis around lips, use of accessory muscles to breathe. Patient is conscious but agitated. History of asthma since childhood, previously well-controlled with inhalers. Currently sitting upright at a table in the café.

History of Events

Timeline:
10:00 hours: Patient arrived at the café, appeared well
10:15 hours: Patient began to feel mild shortness of breath, initially dismissed it as minor
10:20 hours: Shortness of breath worsened rapidly, patient began to wheeze and experience chest tightness
10:22 hours: Patient used his rescue inhaler, no improvement
10:25 hours: Patient called his friend, Jónas, for help
10:27 hours: Jónas called emergency services

Prior Events: Patient has a history of mild to moderate asthma, uses a salbutamol inhaler as needed and a corticosteroid inhaler daily. Last asthma exacerbation was 6 months ago, treated with oral steroids. No known allergies. Last meal was a light breakfast at 08:00. No recent illnesses or changes in medication. Patient reports increased stress levels in the past week.

Diagnostics

Initial Assessment

Initial Impression: Severe Asthma Exacerbation
Justification for F2 Classification:
- Acute respiratory distress with signs of severe exacerbation
- Ineffective response to rescue inhaler
- Potential for rapid deterioration and respiratory failure
- Time-sensitive condition requiring prompt medical intervention

Differential Diagnoses:
1. Severe Asthma Exacerbation (high probability)
2. Anaphylaxis (less likely, no reported allergies or exposure)
3. Pulmonary Embolism (less likely, no risk factors reported)
4. Pneumothorax (less likely, no history of trauma)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen therapy initiation
- Bronchodilator administration
- Preparation for transport to nearest hospital with respiratory support

Final Diagnosis

Final Diagnosis: Severe Acute Asthma Exacerbation
Key Findings:
- Patient's peak expiratory flow rate (PEFR) was significantly reduced
- Arterial blood gas (ABG) analysis revealed hypoxia and hypercapnia
- Chest auscultation confirmed diffuse wheezing and decreased breath sounds
- Patient required nebulized bronchodilators, IV corticosteroids, and oxygen therapy

Outcome validated F2 priority assignment. Rapid intervention was critical to prevent respiratory failure. Patient responded well to treatment and was discharged after 48 hours.

Learning Points:
1. F2 classification appropriate due to the need for rapid intervention
2. Initial assessment accurately identified the severity of the exacerbation
3. Prompt administration of oxygen and bronchodilators were crucial to patient outcome

Emergency Call Transcript